Preoperative Evaluation and Medication PDF

Preoperative Evaluation and Medication AWAD MOHAMMED ALQAHTANI BSc of Anesthesia Technology King Khalid University, Muhayil Asir Objectives  Introduction  Purpose of preoperative evaluation  Components of preoperative evaluation  Anesthesia plan of care  Premedication ...

Preoperative Evaluation and Medication AWAD MOHAMMED ALQAHTANI BSc of Anesthesia Technology King Khalid University, Muhayil Asir Objectives  Introduction  Purpose of preoperative evaluation  Components of preoperative evaluation  Anesthesia plan of care  Premedication  Introduction  Preoperative evaluation is the process by which the anesthetist gets familiar with the patient general condition, medical conditions either old or current, anticipate risks and optimize the patient to undergo safe anesthetic experience.  Purpose of preoperative evaluation  To identify those few patients whose outcomes likely will be improved by implementation of a specific medical treatment.  Identify patients with specific characteristics that likely will influence the proposed anesthetic plan.  It is an opportunity for the anesthetist to describe the proposed anesthetic plan, provide the patient with psychological support, and obtain informed consent for the proposed anesthetic plan from the surgical patient. Components of preoperative evaluation  The cornerstones of an effective preoperative evaluation are the medical history and physical examination, which should include a complete account of all medications taken by the patient in the recent and past, all pertinent drug and contact allergies, and responses and reactions to previous anesthetics.  This evaluation should include any indicated diagnostic tests, imaging procedures, or consultations from other physicians.  The preoperative evaluation guides the anesthetic plan: inadequate preoperative planning and incomplete patient preparation are commonly associated with anesthetic complications.  History A focused preoperative medical history emphasizing:  Cardiac function.  Pulmonary function.  Kidney disease.  Endocrine and metabolic diseases.  Musculoskeletal.  Anatomic issues relevant to airway management and regional anesthesia.  Responses and reactions to previous anesthetics.  Medication use. Physical Examination  The physical examination may detect abnormalities not apparent from the history, and the history helps focus the physical examination.  Examination of healthy asymptomatic patients should include: ◦ measurement of vital signs (blood pressure, heart rate, respiratory rate, and temperature(. ◦ Examination of the airway, heart,lungs, and musculoskeletal system using standard techniques of inspection, auscultation, palpation,and percussion.  Before procedures such as a nerve block, regional anesthesia, or invasive monitoring the relevant anatomy should be examined; evidence of infection near the site or of anatomic abnormalities may contraindicate the planned procedure.  Neurological examination is important when regional anesthesia will likely be used.  The anesthetist must examine the patient’s airway before every anesthetic procedure.The patient’s teeth should be inspected for loose or chipped teeth, caps, bridges, or dentures.  facial abnormalities,Micrognathia, prominent upper incisors, a large tongue, limited range of motion of the temporomandibular joint or cervical spine, or a short or thick neck suggest that difficulty may be encountered in direct laryngoscopy for tracheal intubation.  Cervical spine Large tongue Micrognathia Prominent upper incisors Short or Thick neck Temporomandibular joint  Preoperative Laboratory Testing  Routine laboratory testing when patients are fit and asymptomatic is recommended.  Testing should be guided by the history and physical examination.  ASA physical status American Society of Anesthesiologists  ASA 1 – Healthy patient without organic or psychiatric disease.  ASA 2 - Patient with mild systemic disease.No significant impact on daily activity.Unlikely impact on anesthesia and surgery.  ASA 3 - Significant or severe systemic disease that limits normal activity.Significant impact on daily activity. Likely impact on anesthesia and surgery.  ASA 4 - Severe disease that is a constant threat to life or requires intensive therapy. Serious limitation of daily activity.  ASA 5 - Moribund patient who is equally likely to die in the next 24 hours with or without surgery.  ASA 6 - Brain-dead organ donor.  “E” – added to the classifications indicates emergency surgery.  Informed Consent 1. Frequently questioned in malpractice cases. 2. Risks / benefits. 3. Alternatives. 4. Answer all questions.  MINIMUM FASTING PERIOD, INGESTED MATERIAL APPLIED TO ALL AGES (hr( Clear liquids 2 Breast milk 4 Infant formula 6 Nonhuman milk 6 Light meal (toast and clear liquids( 6 Questions are welcome Thank You  Reference Clinical Anesthesiology 6th edition 2018 the Author ; G.Morgan. Maged Mikhail and Michael Murray, chapter 18, page : 295 – 208.